Comportamiento del condrosarcoma óseo en pacientes menores de 40 años / Chondrosarcoma of bone in young patients

Resumen El condrosarcoma ocupa el segundo lugar en frecuencia, entre los tumores malignos primarios óseos, en pacientes adultos. Típicamente afecta a adultos de entre 40 y 70 años, siendo la mayoría de las series publicadas de este grupo etario. El objetivo de este estudio fue comunicar una serie de pacientes adultos jóvenes (16 a 40 años) con diagnóstico de condrosarcoma óseo, que buscó describir las particularida des en la forma de presentación en esta población. De un total de 37 pacientes de 16 a 40 años operados por condrosarcoma en nuestro centro, entre los años 2008 y 2019, 18 presentaron tumores de bajo grado (G1/tumor cartilaginoso atípico), 16 de grado intermedio (G2), quedando una minoría con tumores de alto grado (2 con condrosarcoma G3 y 1 con un condrosarcoma desdiferenciado). La tasa de supervivencia global fue del 97% (IC 95% 82%-99%) a 2 años y 90.5% (IC 95% 73%-96%) a 5 años y la tasa libre de recurrencia local fue de 92% (IC 95% 77%-97.5%) a los 12 meses y de 89% a los 2 y 5 años (IC 95% 73%-96%). El grado histológico fue el factor pronóstico más relevante. La concordancia del grado histológico entre el diagnóstico preoperatorio de la biopsia y el material de resección quirúrgica fue del 81% (30/37).

Abstract Chondrosarcoma is the second most frequent primary malignant bone tumor. It is typically described in adults between 40 and 70 years of age, being the majority of the series published in this age group. The objective of this study was to report a series of young adults (16-40 years old) with a diagnosis of chondrosarcoma of bone in order to describe the particularities of this tumor in this population. From a total of 37 patients between 16 and 40 years old, surgically treated for chondrosar coma in our institution, 18 had low-grade tumors (G1/atypical cartilaginous tumor), 16 had an intermediate-grade (G2), and a minority had high-grade tumors (2 with a G3 and 1 with a dedifferentiated chondrosarcoma). The overall survival rate was 97% (95% CI 82%-99%) at 2 years of follow-up and 90.5% (95% CI 73-96) at 5 years of follow-up. The local recurrence free rate was 92% (95% CI % 77%-97.5%) at 1 year of follow-up and 89% at 2 and 5 years of follow-up (95% CI 73%-96%). Histological grade was the most relevant prognostic factor. The concordance of the histological grade between the preoperative diagnosis of the biopsy and the surgical resection material was 81% (30/37).

AISYF: first national, prospective, multicenter study of young patients with stroke in Argentina / AISYF: primer estudio nacional, prospectivo y multicéntrico de pacientes jóvenes con ataque cerebral en Argentina

Abstract Up to 15% of all strokes affect young patients and the incidence of ischemic stroke in this population is rising. Nevertheless, there is limited information of cerebrovascular events in this population both in our country and in Latin America. The aim of our study was to evaluate the clinical characteristics and risk factors of young adults with stroke in Argentina. This is a prospective, multicenter study of stroke in young adults (18 - 55 years) in Argentina. Patients presenting with a cerebrovascular event within 180 days were included. Stroke subtypes were classified according to TOAST criteria. A total number of 311 patients were enrolled (men 53.9%, mean age: 43.3 years). Ischemic strokes occurred in 91.8% (brain infarcts 82.6%, transient ischemic attack 9.2%) and hemorrhagic strokes in 8.2%. The most frequent vascular risk factors (including ischemic and hemorrhagic strokes) were: hypertension 120 (41%), smoking 92 (31.4%), dyslipidemia 81 (27.6%) and, over weight/obesity: 74 (25.3%). Stroke subtypes were: large artery disease 12.3%, cardioembolism 7.5, small artery occlusion 11.5%, other defined etiology 27.1%, and undetermined etiology 41.6%. Our study demonstrates that vascular risk factors are very frequent in young adults with stroke. Our findings underline that urgent strategies are required for primary and secondary stroke prevention in this group of patients.

Resumen Aproximadamente un 15% de todos los ataques cerebrovasculares afectan a pacientes jóvenes y su incidencia estaría en aumento. Existe escasa información sobre el ataque cerebral en esta población tanto en nuestro país como en Latinoamérica. El objetivo de nuestro estudio fue evaluar las características clínicas y los factores de riesgo de los adultos jóvenes con ictus en Argentina. Realizamos un estudio prospectivo y multicéntrico en adultos jóvenes (18-55 años) en Argentina, que presentaron un evento cerebrovascular dentro de los 180 días previos. Los subtipos de ictus se clasificaron según los criterios de TOAST. Se incluyeron un total de 311 pacientes (hombres 53.9%, edad media: 43,3 años). Los ataques cerebrovasculares isquémicos ocurrieron en el 91.8% (infartos cerebrales 82.6%, ataque isquémico transitorio 9.2%) y los eventos hemorrágicos correspondieron al 8.2%. Los factores de riesgo vascular más frecuentes (incluyendo los eventos isquémicos y hemorrágicos) fueron: hipertensión 120 (41%), tabaquismo 92 (31.4%), dislipidemia 81 (27.6%) y sobrepeso/obesidad: 74 (25.3%). Los subtipos de ictus isquémicos fueron: arteriopatía de gran vaso 12.3%, cardioembolismo 7.5%, oclusión de pequeña arteria 11.5%, otra etiología definida 27.1% y etiología indeterminada 41.6%. Los factores de riesgo vascular son muy frecuentes en los adultos jóvenes con ictus. Nuestros hallazgos subrayan que se requieren estrategias urgentes para la prevención primaria y secundaria del ictus en este grupo particular de pacientes en nuestro país.

Complicación de una fractura bilateral acetabular después de múltiples cirugías y 30 años de evolución. Presentación de un caso / Complication of a bilateral acetabular fracture after multiple surgeries and 30 years of evolution. Presentation of a case

Resumen Fractura acetabular bilateral, reducción abierta y fijación interna, sin lograrse reducción anatómica; requirió colocación de prótesis totales a corto plazo, ambas cementadas. Se llevó a cabo una revisión de ambos componentes de cadera izquierda a los ocho años por aflojamiento de la copa y del vástago, con componentes no cementados. El fémur evolucionó de manera satisfactoria, no así el acetábulo, que requirió seis revisiones subsecuentes, con injertos óseos y colocación de refuerzos metálicos, inicialmente muy estables, pero con ruptura de tornillos y falta de osteointegración tanto de los implantes como de los injertos a los 12 y 18 meses en los diferentes eventos quirúrgicos. Desarrolló pseudoaneurisma de la arteria iliaca externa izquierda, tratado por un cirujano vascular; se complicó con infección local primero e infección profunda de cadera izquierda por Staphylococcus aureus después. Se trató con retiro de los implantes en iliaco y utilizando polimetilmetacrilato con antibiótico como relleno del gran defecto óseo mientras se controló la infección, terminando con una prótesis de rescate en silla de montar (Link, Hamburgo). En la actualidad, tiene buena función, sin dolor, pero con movilidad limitada, sobre todo la flexión. La cadera derecha se ha revisado una sola vez; la copa acetabular empezó a migrar cefálica y vertical, pero sin perder estabilidad, al poco tiempo del aflojamiento de la izquierda; nunca desarrolló compromiso del vástago femoral, permitiéndole una función aceptable y siendo «su pierna buena¼ durante el tiempo de disfunción de la cadera izquierda. Se revisó colocando injerto óseo estructural con dos cabezas femorales de cadáver y cementando una nueva copa. La recuperación de la paciente ha sido muy buena; se ha reintegrado a la vida activa, en la que se vale por sí misma para todas sus actividades cotidianas; utiliza una muleta con la mano derecha, maneja una camioneta, no tiene dolor.

Abstract Bilateral acetabular fracture, open reduction and internal fixation, without achieving anatomical reduction; it required placement of short-term total prostheses, both cemented. We made a revision of both left hip components in the eighth year because of loosening of the cup and stem, with uncemented components. The femur evolved satisfactorily, but the acetabulum required six subsequent revisions, with bone grafts and placement of metal reinforcements, initially very stable, but with screw rupture and lack of osseointegration of both implants and grafts at 12 and 18 months in the different surgical events. She developed pseudoaneurysm of the left external iliac artery, treated by a vascular surgeon; it got complicated with local infection first and later, deep infection of the left hip by Staphylococcus aureus. The implants were removed from the iliac and polymethylmethacrylate with antibiotics was used to fill the large bone defect while the infection was being controlled, ending with a saddle rescue prosthesis (Link, Hamburg). It currently has a good function, without pain, but with limited mobility, especially flexion. The right hip has only been checked once; the acetabular cup began to migrate cephalically and vertically, but without losing stability, shortly after the loosening of the left one; it never developed femoral stem involvement, allowing acceptable function and being «her good leg¼ during the time of the left hip dysfunction. It was reviewed by placing a structural bone graft with two femoral heads from a corpse and cementing a new cup. The patient's recovery has been very good, returning to an active life in which she is self-sufficient in all her daily activities; uses a crutch with her right hand, drives a van, is pain-free.

Cáncer en pacientes jóvenes (Parte 2) Carcinomas de cavidad bucal en sujetos de bajo riesgo: presentación de 4 casos y revisión de la literatura / Oral cancers in low-risk subjects: presentation of 4 cases and literature review

El cáncer en cavidad bucal y de la región de cabeza y cuello se presenta con mayor frecuencia entre la quinta y sexta década de la vida generalmente atribuido al uso indiscriminado de substancias como el alcohol y el tabaco por un periodo de tiempo considerable. Sin embargo estudios recientes demuestran un incremento en la incidencia en pacientes jóvenes que nunca estuvieron expuestos a estos y a otros factores como riesgo ocupacional, predisposición genética, dieta. Se presenta 4 casos de carcinomas en cavidad bucal y revisión de la literatura.

Oral cavity cancer and head and neck region occurs most often between the fifth and sixth decade of life and is generally attributed to the indiscriminate use of substances such as alcohol and snuff for a period of time. However, recent studies show an increased incidence in younger patients who have never been exposed to these and other risk factors such as occupational factors, genetic predisposition, diet. Four cases of oral carcinoma are presented as well as a literature review.

Cáncer en pacientes Jóvenes (Parte 1)Análisis clínico e histopatológico de carcinoma de células escamosas de la cavidad bucal en pacientes jóvenes. Un estudio descriptivo y comparativo en México / Cancer in young patients (Part 1). Clinical and histopathological analysis of squamous cell carcinoma of the oral cavity in young patients A descriptive and comparative study in Mexico

El cáncer en cavidad bucal y de la región de cabeza y cuello se presenta con mayor frecuencia entre la quinta y sexta década de la vida generalmente atribuido al uso indiscriminado de substancias como el alcohol y el tabaco por un periodo de tiempo considerable. Sin embargo estudios recientes demuestran un incremento en la incidencia en pacientes jóvenes que nunca estuvieron expuestos a estos y a otros factores como riesgo ocupacional, predisposición genética, dieta...

Oral cavity and head and neck cancer occurs most often between the fifth and sixth decade of life and is generally attributed to the indiscriminate use of substances such as alcohol and tobacco snuff for a considerable amount of time. However, recent studies show an increased incidence in younger patients who have never been exposed to these and other risk factors such as occupational risk, genetic predisposition and diet...

Aumento en la incidencia de cáncer colorrectal en pacientes jóvenes en un Hospital General de Agudos / Increase in the incidence of colorectal cancer in young patients at a general hospital

Introducción: El cáncer colorrectal es la neoplasia más frecuente del tubo digestivo y la tercera en nuestro país en mortalidad e incidencia. Ésta ha aumentado en los últimos años y parece comprometer a pacientes cada vez más jóvenes. Objetivo: Evaluar la variación en la incidencia de cáncer colorrectal en pacientes menores de 50 años en un Hospital General de Agudos. Lugar de aplicación: Hospital General de Agudos de la Ciudad de Buenos Aires. Diseño: Análisis comparativo retrospectivo. Población y Métodos: Se evalúan 747 pacientes operados por cáncer colorrectal en dos periodos consecutivos, el primero desde 1995 hasta 2001 y el segundo de 2002 a 2008. Resultados: En el primer periodo se operaron 300 pacientes, de los cuales 22 (7 por ciento) eran menores de 50 años. En el segundo se operaron 474 pacientes, 58 menores de 50 años (12 por ciento). La media de edad para la población de pacientes jóvenes fue de 40.8 años con rango de 15 a 50 años. No hubo diferencias en relación al sexo (41 F:39 M), 2 pacientes refirieron antecedentes familiares de cáncer colorrectal. La proctorragia y el dolor abdominal fueron los primeros síntomas. El recto fue la localización más frecuente (45 por ciento), seguido por el cáncer de colon derecho (29 por ciento). La resección anterior baja fue la cirugía más efectuada seguida por la colectomía derecha. La mayoría de los pacientes (82.5 por ciento) se operaron en estadio III. Conclusiones: La incidencia de cáncer colorrectal en pacientes jóvenes ha aumentado en nuestro servicio en los últimos años. Los pacientes consultan en estadios avanzados.

Introduction: Colorectal cancer is the most common neoplasm of the digestive tract and the third in our country in mortality and incidence. In the last years there has been increase in its incidence, and it seems to affect younger patients. Aim: To evaluate the incidence of colorectal cancer in patients younger than 50 years in a General Hospital. Design: Retrospective and comparative trial. Patients and Methods: 747 patients treated for colorectal cancer in two consecutives periods, the first since 1995 to 2001 and the second since 2002 to 2008 in a General Hospital. Results: In the first period 300 patients were treated, 22 of them (7 per cent) younger than 50 years. In the second period 474 were treated and 58 (12 per cent) younger than 50 years. Mean age for the younger patients was 40.8 years, range 15-50 years. There was no difference in sex (41 F:39 M), and 2 patients had a family history of colorectal cancer. The first symptoms were gastrointestinal bleeding and abdominal pain. The rectal localization was the most common (45 per cent), followed by the right colon (29 per cent). Low anterior rectal resection and right colectomy were the most common procedures, followed by right colectomy. The majority of our patients (76 per cent) were treated in stage III. Conclusions: The incidence of colorectal cancer in younger patients has increased in the last years in our practice. These patients usually consult at an advanced stage.

Periodontitis agresiva: Diagnóstico y tratamiento

El tratamiento de la Periodontitis Agresiva, debe estar basado en el diagnóstico preciso de la enfermedad, reducción o eliminación de los agentes causales, manejo de los factores de riesgos y la corrección de los efectos de la enfermedad sobre los tejidos periodontales. Para llegar a un correcto diagnóstico de la Periodontitis Agresiva se debe evaluar la información obtenida de manera sistemática a través de: la entrevista con el paciente, examen médico, cuándo este indicado, examen clínico: periodontal, radiográfico y de laboratorio cuándo sea necesario. En la actualidad se están investigando diferentes ensayos diagnósticos a fin de mejorar la capacidad para predecir susceptibilidad y futura progresión de enfermedad. El tratamiento periodontal de la enfermedad puede fracasar o resultar menos efectivo, independientemente del tipo de tratamiento aplicado, si no se establece un plan de mantenimiento adecuado para el paciente.

The treatment for the aggressive periodontitis should be based in an accurate diagnosis of the disease, reduction or elimination causal agents, management of risk factors and the elimination of the effects of the disease on the periodontal tissues. An accurate diagnosis only can be done with a systematic evaluation of the information obtained by interviewing the patient, medical check up, when it is indicated, an extensive clinical examination of periodontal tissues, radiographic and laboratory test when it is considered necessary. There are currently investigations on different diagnostic tests with the objective of improving the capacity to predict the susceptibility and the progression of the disease. The periodontal therapy can fail or be less effective independently of the type of treatment if an adequately plan of maintenance is not applied to the patient.

Apego al tratamiento psicoterapéutico grupal en pacientes con Trastorno Límite de la Personalidad. Estudio piloto en pacientes de 18 a 24 años

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Abstract: The treatment of election for patients with Borderline Personality Disorder (BPD), consists on the combination of psychotherapy and pharmacotherapy. Concerning a psychoanalitic and individual focuse, there has been found, that in spite of the differences in orientations and the therapists experience, the manifestations of the disorder tend to decrease. First of all, a decrease in the impulsivity and an increase in the affective stability is seen, whether the identity alterations modify poorly with treatments of a duration of up to two years. Traditionally, patients with BPD have not been considered apt for group therapy, because their disruptive behavior interferes with the development of the groupal cohesion; however, this characteristics are the ones that can be rapidly treated in the group, when putting a slight pressure on the patient so he can modify this maladaptive behavior. The objectives of group therapy, are consistent with the ones in individual therapy. They include stability for patients, management of impulsivity and other symptoms, and management of the reactions in the transference and countertransference. The presence of other patients helps to establish limits between the participants and it also generates an altruistic interaction, in which they can consolídate their changes in the process of helping others. Group therapists suggest that individual therapy can be accelerated if the patient participates in the group in which the primitive fantasies are stimulated and where the group structure provides a support that helps personal growth. One of the most difficult tasks in any therapy is the desertion of the patients. Specially, the group is vulnerable to desertion, in its initial stage, since it has been recorded that there is a 13 to 63% of desertions. The purpose of the present study was to determine the psychological and psychopathological variables in patients with BPD, that influence the compliance in a group therapy. All the candidates in this investigation were patients with a probable diagnose of BPD, that had been sent to the Psychotherapy Department of National Institute of Psychiatry, aged between 18 to 24 years. This diagnose was corroborated with the SCID II. A descriptive study was made with the characteristics of the patients in some different areas: character and temperament, self esteem, quality of life, psychosocial functioning, interpersonal problems, ego strength, and psychiatric symptoms. A total of 24 weekly sessions with a duration of an hour and a half, were conducted under the direction of two psychotherapists and a non active observer. A Spearman correlation was used to correlate the psychological variables with the number of assisted sessions. We included 16 female patients, with an age mean of 20.43 years; the mean of assistance to the group was of 4.5 sessions. None of the subjects assisted to all the 24 sessions and 56% of the patients deserted the group as well as the pharmacological treatment. The findings of the correlations between the number of assisted sessions and the psychological variables, suggested first of all, a positive relation between the persistence scale of the ITC and a negative association with the subscales 1 (preoccupation vs optimism) and 4 (fatigability vs energy). Other findings suggested negative correlations between the psychosis scale of the SCL 90 and the evitative scale. The rest of the scales did not have a significative correlation with the number of assisted sessions. The items mentioned during the sessions by the patients consisted in the extreme dependency to the external criticism, that came from significative figures. The patients also talked about some of the common symptoms of BPD, like frustration, intolerance, suicide, lack of affective stability, self mutilations, rage, ambivalence, poor self concept, feelings of inferiority, and low self esteem. The percentage of desertion in this study was a lot higher than expected, assuming that in a regular group basis, there is 30% to 40% of desertion. It also came to our attention, that groupal phenomena, were not observed. Specially identifications and groupal cohesion, were not developed in this case. The patients collaborated exclusively with the therapists; they did not give any devolutions to other patients. They all waited for their turn, changing the theme, in a way that satisfied their own conflicts. The universality of the experience phenomenon was no seen, since the patients, did not feel that the others had the same problems, conflicts emotions or ideas, feeling supported or relieved by it. In conclusion, the patients with BPD, in our institution have a bad compliance in a group therapy, in which only personality disorders are admitted. These patients did not blend within the environment, because the groupal phenomena that produce the changes were not seen at all. This is probably associated with the intrinsic characteristics of the disorder, and this is why the probable changes in the patients should be evaluated and this technique questioned, as a reliable treatment method for personality disorders. A comparison of this technique with others, such as individual therapy and the combination of both, should be also considered. The Psychobiologic model of Cloninger, used in other investigations to predict the efficacy of pharmacotherapy, can be used to make a prediction of the compliance of BPD with groupal therapy. This data should be considered in the previous evaluation of the patients, with the goal of establishing different strategies, and an adequate treatment, for subjects with these characteristics.